The Caribbean faces a severe public health crisis defined by a disproportionately high burden of Non-Communicable Diseases (NCDs). NCDs, which include diabetes, heart disease, cancer, and cerebrovascular disease, are the leading cause of mortality across the region.
In 2016, NCDs accounted for a staggering 76.8% of all deaths in the Caribbean, significantly surpassing the 65% average recorded across the wider Americas region in 2021. In 22 Caribbean countries and territories surveyed, these four primary NCDs were responsible for 39% to 67% of all mortality, with heart disease being the foremost contributor in most territories (ranging from 13% to 25% of deaths). https://carpha.org/What-We-Do/NCD/Overview#:~:text=In%20the%20Caribbean%20Region%2C%20NCDs,of%20death%20due%20to%20NCDs.
Physical inactivity is identified as one of the primary modifiable risk factors driving the surge in NCD deaths across the Americas. While the prevalence of physical inactivity rose regionally to 35.6% in 2022, the situation is particularly concerning in the Caribbean context. Data indicates that physical inactivity affects over 60% of Caribbean young adults (18–25 years old). This high rate of non-participation in adequate physical activity correlates directly with a concerning early-onset risk factor profile: over 50% of young adults in the region exhibit at least one component of metabolic syndrome, such as overweight, obesity, or elevated blood pressure.
Physical activity offers several healthy benefits. Aerobic training improves cardiorespiratory fitness, increases mitochondrial density, and enhances the compliance and reactivity of blood vessels. In patients with Type 1 diabetes, aerobic training improves lipid profiles and endothelial function. Given that diabetes is an independent risk factor for accelerated decline in muscle strength and functional status, resistance training is a necessary component of treatment.
Furthermore, flexibility and balance exercises are essential for older adults with diabetes to maintain mobility and prevent falls.
· A key challenge lies in the physical and infrastructural environment. Many communities exhibit limited opportunities for active commuting, often due to poor sidewalk infrastructure or long distances between residences, workplaces, and commerce centres, which leads to a preference for driving or motorised transit.
· Furthermore, organised exercise opportunities, such as gyms or classes, are often perceived as expensive or inconvenient, especially for individuals with limited disposable income. Within the home, limited indoor space is also cited as a barrier to exercise.
· Climate change impacts, including rising temperatures, increased humidity, and altered rainfall patterns, pose significant challenges to sustained outdoor exercise.
· Moreover, concerns about personal safety, particularly walking at night, contribute to reduced physical activity participation.
· Socio-cultural expectations impose significant constraints, particularly on women. Family responsibilities, such as childcare, frequently take precedence over personal time for exercise, leading to acute “time scarcity” which disproportionately affects female participants.
To effectively leverage physical activity against the NCD policy efforts must move beyond awareness campaigns and focus on system-level structural and clinical integration.
1. Mandatory Exercise Prescription: Governments must formally mandate the prescription of physical activity by primary care providers as a first-line clinical treatment for NCDs, not merely a lifestyle recommendation.
2. Engaging Physical Activity Specialists: Integrate specialised physical activity professionals (physical therapists, exercise physiologists) into primary care teams across the region. This will be aligned to dieticians at health care centres
3. Active Urban Planning: Physical activity must be included in new urban planning and housing developments. This includes adequate lighting, green spaces, and community facilities.
4. Equity-Based Community Programming: Public health programmes must prioritise community-based, low-cost, or free physical activity programmes that specifically address the socioeconomic and gendered barriers.
